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USE OF NEWER AGENTS

Posted: Jan 20, 2008

QUESTION:

i have a very experienced pt with noncompliance issues cannot tolerate norvir... She is on Epizcom , Lexiva and Norvir I am getting a genotype and phenotype--- prior she had K103 only... I would like to try newer agents.. Is it okay to use Darunavir W/O NORVIR AND ADD ISENTRESS AND IF ABLE MAVAROIC WITH A BACKBONE NRTI


  

RESPONSE FROM:   

    Thank you for your post.

    Unfortunately, darunavir (Prezista) cannot be used without ritonavir. However, the tolerability of the combination is remarkably good and I've had some patients who were intolerant of older boosted PIs tolerate a boosted darunavir regimen. Alternatively, one could consider using an unboosted PI- namely atazanavir or fosamprenavir- if your patient does not have significant PI resistance.

    Clearly, getting the phenotype and genotype data will help sort out options- if your patient only had previous K103N NNRTI resistance, there's also a good chance that (in addition to raltegravir and maraviroc), she'd be susceptible to the new NNRTI, etravirine (TMC 125).

    Sorting out the susceptibility, tolerability and adherence issues will be very important for your patient.

    Let us know how she does, BY




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